Provider Demographics
NPI:1801959382
Name:EDWIN-ENYENIHI, ARIT ENYENIHI (MD)
Entity type:Individual
Prefix:
First Name:ARIT
Middle Name:ENYENIHI
Last Name:EDWIN-ENYENIHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ARIT
Other - Middle Name:ENYENIHI
Other - Last Name:MBAGWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3860 CALLE FORTUNADA
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4800
Mailing Address - Country:US
Mailing Address - Phone:858-309-6303
Mailing Address - Fax:858-309-6301
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-8036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53833208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A538330Medicaid
CA00A538330Medicaid
CAWA53833AMedicare ID - Type Unspecified